From the Guidelines
Percutaneous fixation of calcaneus fractures is a viable alternative to open fixation, with potential benefits in reducing soft tissue complications and promoting faster recovery, although the optimal approach remains controversial and dependent on individual patient factors. When managing calcaneus fractures, it is essential to consider the potential benefits and drawbacks of each surgical approach. The traditional open reduction and internal fixation (ORIF) technique allows for direct visualization and anatomic reduction of fracture fragments but is associated with significant soft tissue complications, including wound dehiscence, infection, and sural nerve damage 1. In contrast, percutaneous fixation techniques have gained popularity as potentially less invasive alternatives that may reduce soft tissue complications while providing adequate fracture stabilization. Key considerations in the management of calcaneus fractures include:
- The severity and displacement of the fracture
- The patient's overall health and comorbidities
- The potential for soft tissue complications
- The need for anatomic reduction and stable fixation
- The potential benefits of minimally invasive techniques in promoting faster recovery and reducing complications. Our case series aims to compare the clinical outcomes, complication rates, and functional results between percutaneous and open fixation techniques for calcaneus fractures, providing evidence to guide surgical decision-making for these challenging injuries. By analyzing postoperative pain scores, return to function, wound complications, and radiographic outcomes, we seek to identify which patient populations might benefit most from each approach and inform the development of personalized treatment strategies. The optimal surgical management of displaced intra-articular calcaneus fractures remains a topic of ongoing debate, and further research is needed to fully elucidate the relative benefits and drawbacks of each approach 1.
From the Research
Background
- Calcaneus fractures are a common type of foot injury, with displaced intra-articular fractures being particularly challenging to treat 2, 3.
- The ideal treatment approach for calcaneus fractures remains a subject of debate, with both open reduction and internal fixation (ORIF) and percutaneous fixation being used 2, 4, 5.
Treatment Approaches
- Open reduction and internal fixation (ORIF) is a traditional approach that involves making an incision to access the fracture site and using plates and screws to stabilize the bone 2, 6.
- Percutaneous fixation is a less invasive approach that involves using screws or other fixation devices to stabilize the bone through small incisions 3, 4, 5.
- The choice of treatment approach depends on the type and severity of the fracture, as well as the patient's overall health and medical history 3, 6.
Comparison of Treatment Outcomes
- Studies have compared the outcomes of ORIF and percutaneous fixation for calcaneus fractures, with some finding similar reduction results and improved outcomes for percutaneous fixation in terms of length of stay, pain, and complication rates 4, 5.
- Other studies have found that ORIF can provide good to excellent results in terms of anatomical reduction and functional outcomes, but may be associated with a higher risk of wound complications 2, 6.
Indications and Techniques
- The sinus tarsi approach is becoming a popular approach for ORIF of calcaneus fractures, as it allows for good exposure of the fracture site and minimizes the risk of wound complications 3, 6.
- Primary subtalar arthrodesis is a valuable option for cases with severe comminution or when anatomic reduction cannot be obtained, but requires careful consideration of the overall anatomy of the calcaneus 6.